S2160 Safety of ERCP in Cancer Patients Taking Long-Acting Anti-VEGF Agents

Introduction: Anti-vascular endothelial growth factor (VEGF) agents are effective in the management of colorectal cancer and other gastrointestinal malignancies but are associated with gastrointestinal bleeding and perforation. Weeks of pre- and post-surgical treatment interruption are suggested to avoid post-operative wound healing complications. There is minimal guidance and scarce data on the safety of these agents before and after endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to review ERCP outcomes in patients taking these agents. Methods: A retrospective review was performed of ERCP outcomes over a 7-year period (2016-2023) in patients taking long-acting anti-VEGF agents within 8 weeks of ERCP at our tertiary cancer center. Results: Seventy-eight patients undergoing 148 ERCPs were included. Mean age was 55.2 years and 62.8% were men. Most patients were on bevacizumab (82.1%). Sphincterotomy was performed in 31.8% and biliary dilation in 37.2%. The technical and clinical success rates of ERCP were 96.6% (95% confidence interval [CI]: 92.2-98.9%) and 69.3% (95% CI: 60.9-76.9%) respectively. The cumulative risk of adverse events post-ERCP was 29.1% (95% CI: 21.9-37.1%), the most common being cholangitis (8.1% [95% CI: 4.3-13.7%]) and bleeding (5.4% [95% CI: 2.4-10.3%]). Perforation occurred in one patient (0.7% [95% CI: 0.02-3.7%]) who was managed conservatively. Median survival post-ERCP was 108 days (95% CI: 71-169 days). On logistic regression, recent dosing (receiving an anti-VEGF dose within 2 weeks of ERCP) and intensive dosing (receiving more than 2 doses within 8 weeks of ERCP) were not independent predictors of an adverse event occurring post-ERCP. Conclusion: Performing ERCP in patients on anti-VEGF agents may be associated with relatively increased risks of cholangitis and bleeding. Recent and more intensive anti-VEGF dosing do not seem to independently increase the risk of adverse events.